Archives of pediatrics & adolescent medicine最新文献

Objective: To describe the clinical presentations and outcomes of children with intraventricular hemorrhages (IVHs) after blunt head trauma (BHT).

Design: Subanalysis of a large, prospective, observational cohort study performed from June 1, 2004, through September 31, 2006.

Setting: Twenty-five emergency departments participating in the Pediatric Emergency Care Applied Research Network. Patients Children presenting with IVH after BHT. Exposure Blunt head trauma.

Main outcome measures: Clinical presentations and outcomes, including the Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scores at hospital discharge.

Results: Of 15 907 patients evaluated with computed tomography, 1156 (7.3%) had intracranial injuries. Forty-three of the 1156 (3.7%; 95% CI, 2.7%-5.0%) had nonisolated IVHs (ie, with intracranial injuries on computed tomography), and 10 of 1156 (0.9%; 95% CI, 0.4%-1.6%) had isolated IVHs. Only 4 of 43 (9.3%) of those with nonisolated IVHs had Glasgow Coma Scale (GCS) scores of 14 to 15, and all 10 (100.0%) with isolated IVHs had GCS scores of 15. No patients with isolated IVHs required neurosurgery or died. One patient had moderate overall disability (by the POPC score), and no patient had moderate or severe disability at discharge (by the PCPC score). Of the 43 patients with nonisolated IVHs, however, 16 (37.2%) died and 18 (41.9%) required neurosurgery. In 27 patients (62.8%), injuries ranged from moderate overall disability to brain death by the POPC score.

Conclusions: Children with nonisolated IVHs after BHT typically present with GCS scores of less than 14, frequently require neurosurgery, and have high mortality rates. In contrast, those with isolated IVHs typically present with normal mental status and are at low risk for acute adverse events and poor outcomes.

OBJECTIVE To test the ability of a 3-item screening tool (Parenting Responsibility and Emotional Preparedness [PREP]) to detect adolescent mothers at elevated risk for nonoptimal parenting and poor child development outcomes at 2 years of age. DESIGN A 4-site prospective cohort study conducted from December 2001 to August 2007 of adolescent mothers recruited in the third trimester of pregnancy and followed up at 4, 8, 18, and 24 months post partum. SETTING Community clinics and home settings in Birmingham, Alabama; Kansas City, Kansas and Missouri; South Bend, Indiana; and Washington, DC. PARTICIPANTS A total of 270 first-time adolescent mothers (aged 15-19 years) and their infants (birth to 2 years of age). MAIN EXPOSURES Naturalistic observations of parent-child interactions and quality of home environment during the first 2 years of life. OUTCOME MEASURES Maternal mental health and cognitive indicators, positive mother-child interactions, quality of home environment, child social-emotional development, and child cognitive development (Bayley scales). RESULTS PREP scores identified adolescent mothers with significantly elevated depressive symptoms and childhood trauma and lower scores of knowledge of infant development and maternal IQ. PREP predicted significantly lower quality of home environments and higher levels of nonoptimal mother-child interactions at 4, 8, and 18 months. PREP also predicted significantly lower child outcomes at 2 years of age for cognitive scores and higher levels of depressive and withdrawal symptoms and dysregulation and negative emotionality. CONCLUSIONS PREP is a low-cost, easily administered, nonstigmatizing screening tool that identifies adolescent mothers who self-recognize that they need help to meet their infants' social, emotional, and cognitive needs.